EDIFACT: The universal message standard

What is EDIFACT?

EDIFACT is the abbreviation for "Electronic Data Interchange for Administration, Commerce and Transport". This is a global set of rules defined by the UN for the inter-company electronic data exchange between two or more business partners via EDI.

It should be noted that EDIFACT is a newer standard for EDI than ANSII X12. X12 is mainly used in America, while EDIFACT is a world-wide standard.

The goal of EDIFACT is the optimization and standardization of the data flow between business partners. By defining uniform segments and elements that describe the information in the electronic file and which are used for a wide variety of document types (such as invoices, purchase orders, delivery notes, etc.) merely by means of a differentiated arrangement, a worldwide standard was created.

However, the EDIFACT standard is very comprehensive and created for almost every business transaction and every industry, subgroups (the so-called subsets) soon emerged. The subset EANCOM was created for the retail sector, which contains the mandatory fields of the EDIFACT standard and the industry-specific optional fields. By creating so-called subsets, the messages are better handled and easier to understand.

Addenda – Refers to a version of the HIPAA mandated transaction sets that corrects identified implementation issues noted in the original TR3.

ASC X12N/005010X222– The HIPAA mandated (ANSI) ASC X12N Professional Health Care Claim transaction format.

ASC X12N/005010X222A1 – The Type 1 Errata modifications mandated for use with the ASC X12N/005010X222 837 Professional Health Care Claim transaction format.

BCBSM or FEP Supplemental – BCBSM or FEP is being billed as the secondary payer and the primary payer is original Medicare or any type of Medicare Advantage or Medicare Advantage HMO.

BCBSA – An acronym for Blue Cross Blue Shield Association

BCC – An acronym for Blue Cross Complete of Michigan, a Medicaid managed care plan

BCN – An acronym for Blue Care Network

BlueExchange – A BCBSA process through which non-claim HIPAA transactions for members from all other Blue Cross and/or Blue Shield plans that are governed by the BCBSA can be accepted by a local host plan (the plan that delivers the benefits to a member) and routed to the home plan (the plan that covers the member) for processing.

Data Segment – Corresponds to a record in data processing terminology. Consists of logically related data elements in a defined sequence (defined by X12N). Each segment begins with a segment identifier, which is not a data element and one or more related data elements, which are preceded by a data element separator. Each segment ends with a segment terminator.

Data Element – Corresponds to a field in data processing terminology. Assigned unique reference number. Each element has a name, description, type, minimum length and maximum length. The length of an element is the number of character positions used, except as noted for numeric, decimal and binary elements. Data element types are defined in Appendices B of the TR3.

Delimiter – A character used to separate two data elements (or sub-elements) or to end a segment. They are specified in the interchange header segment (ISA). Once specified in the ISA, they should not be used in the data elsewhere other than as a separator or terminator.

EDI – An acronym for Electronic Data Interchange.

Electronic Data Interchange – The application-to-application transfer of key business information transacted in a standard format using a computer-to-computer communications link. There are typically 6 components used in order to do EDI. They are: an EDI file, a trading partner, an application file/form, translator (mapper), communications and value-added network or value-added service provider.

FEP – Federal Employee Program

Interface – The point at which two systems connect to pass data

Loops – Loops are groups of semantically related segments. Data segment loops may be unbounded or bounded.

Medicare Beneficiary Identifier (MBI) – an eleven-character alpha numeric identification number issued by the Center for Medicare Services, which replaces the Medicare Health Insurance Claim Number (HICN).

NASCO – The National Account Service Company connects several Blue Cross and Blue Shield plans across the country through a common automated system to administer health benefit programs.

Routing – Separation of data based on specific criteria for subsequent transfer to an internal or external system.

Technical Reports Type 3 (TR3s) – Documents that provide standardized data requirements and content as the specifications for consistent implementation of a standard transaction set. The Washington Publishing Company publishes HIPAA TR3s on their web site: http://store.x12.org/store/

Trading partners – Companies/Entities that exchange electronic data files. Agreements are sometimes made between the partners to define the parameters of the data exchange and simplify the implementation process.

Transaction Set – A transaction set is considered one business document which is composed of a transaction set header control segment, one or more data segments, and a transaction set trailer control segment.

X12 - An Accredited Standards Committee commissioned by the American National Standards Institute to develop standards for Electronic Data Interchange

X12N – An Accredited Standards Committee commissioned by the American National Standards Institute to develop standards for Electronic Data Interchange. While X12 indicates EDI, the N identifies the Insurance Subcommittee that is responsible for developing EDI standards for the insurance industry. There is a special health care task group within this subcommittee responsible for the development of health care insurance transactions.

Affordable EDI for Micro, Small and Mid-Sized Business

At EDI Shack we believe every company with some technology knowledge should be able to do EDI. As Such, we supply some Open-Source and FREE (MIT License) libraries you can use to get started with EDI. We'll also try very hard to keep you from making the most common EDI mistakes.

What is the Number 1 EDI Mistake? Thinking EDI is just creating a strangely formatted file and sending it to your trading partner. In reality, what you're doing is pulling some data from your system, and putting it into your trading partners' system, using a strangely formatted file, or even scarier for you, you're taking data from your trading partner and putting it directly into your system using a strangely formatted file. If that doesn't scare you, it should. Any mistake in your, or your partners' EDI implementation is going straight into your data.

In fact, managing your EDI files and keeping track of what's in them is just as important as creating the file.

The EDI-Laravel framework is designed to give smaller companies a complete, easy to use EDI system. With a little basic EDI knowledge, you can create new transaction sets, and link them to transmission objects to send the files via FTP, FTPS, SFTP, HTTPS, or AS2 without any programming whatsoever. If you can program in PHP, you can do anything, quickly and easily.

Let's face it. EDI is expensive and confusing. EDI is also one of the simplest technologies there is, but it can also be incredibly pricy and complex. EDI Shack is dedicated to make EDI simple for small and mid-sized companies.